本文選題：醫(yī)院建筑　切入點(diǎn)：醫(yī)療安全　出處：《哈爾濱工業(yè)大學(xué)》2017年博士論文　論文類型：學(xué)位論文

【摘要】：對(duì)醫(yī)療安全進(jìn)行建筑學(xué)角度的理性思考是一種時(shí)代的需求。本研究致力于探析影響醫(yī)療安全的建筑空間環(huán)境要素,為相關(guān)風(fēng)險(xiǎn)控制提供理論和實(shí)踐層面的依據(jù)。醫(yī)療安全是一個(gè)嚴(yán)肅的公共衛(wèi)生問題,事關(guān)生命健康、社會(huì)穩(wěn)定。頻發(fā)的醫(yī)院安全事件顯示出現(xiàn)階段我國的醫(yī)療安全水平并未滿足人們的安全需求。醫(yī)療安全風(fēng)險(xiǎn)控制是一項(xiàng)系統(tǒng)工程,建筑空間環(huán)境作為承載醫(yī)療活動(dòng)的平臺(tái)是風(fēng)險(xiǎn)控制的重要組成部分,醫(yī)院建筑設(shè)計(jì)的安全不僅是本體安全,更重要的是保障醫(yī)療安全這個(gè)核心目標(biāo),建筑學(xué)科必須承擔(dān)起在系統(tǒng)工程中的角色,從建筑領(lǐng)域出發(fā)尋找解決醫(yī)療安全問題的新途徑,并最終實(shí)現(xiàn)促進(jìn)社會(huì)發(fā)展和個(gè)體自由的目標(biāo)。本研究從醫(yī)療安全的視角出發(fā),以系統(tǒng)論、安全學(xué)的相關(guān)思想為指導(dǎo),以醫(yī)學(xué)的經(jīng)驗(yàn)反饋和實(shí)際調(diào)研數(shù)據(jù)為依據(jù),以空間環(huán)境對(duì)行為心理的影響為連接,完成了醫(yī)療安全與空間環(huán)境要素在理論研究和實(shí)踐操作兩個(gè)層面的對(duì)接,完善了醫(yī)院建筑設(shè)計(jì)的安全觀,為具體的風(fēng)險(xiǎn)控制和設(shè)計(jì)實(shí)踐提供依據(jù),以期達(dá)到發(fā)揮空間環(huán)境對(duì)醫(yī)療活動(dòng)的積極作用,規(guī)避或降低空間環(huán)境對(duì)醫(yī)療活動(dòng)的負(fù)面影響。篩選與空間環(huán)境密切相關(guān)且重要的醫(yī)療安全問題進(jìn)行深入研究是形成具有可操作性成果的前提,因此本研究立足多個(gè)環(huán)節(jié)的調(diào)研挖掘,確立了四方面問題,依次為醫(yī)療失誤、醫(yī)源性感染、意外傷害、職業(yè)暴露。在此基礎(chǔ)上針對(duì)每個(gè)問題按照“問題屬性分析——作用機(jī)制解析——風(fēng)險(xiǎn)要素提取——風(fēng)險(xiǎn)等級(jí)分析——風(fēng)險(xiǎn)控制模型建構(gòu)——提出風(fēng)險(xiǎn)控制策略”的思路進(jìn)行專項(xiàng)研究。本研究首先明晰了空間環(huán)境與醫(yī)療安全之間的作用機(jī)制,二者關(guān)系的清晰認(rèn)識(shí)是風(fēng)險(xiǎn)控制的基礎(chǔ)。其次,通過醫(yī)療安全的數(shù)據(jù)查閱、醫(yī)院環(huán)境的實(shí)況觀察、醫(yī)護(hù)專家訪談等多個(gè)渠道對(duì)上述四大醫(yī)療安全問題的具體空間環(huán)境影響要素進(jìn)行遴選,是為風(fēng)險(xiǎn)識(shí)別。再次,對(duì)空間環(huán)境要素的風(fēng)險(xiǎn)等級(jí)運(yùn)用非交鋒式專家意見法進(jìn)行征集,根據(jù)影響程度和作用頻度兩個(gè)方向綜合確定了空間環(huán)境要素的風(fēng)險(xiǎn)等級(jí),并對(duì)風(fēng)險(xiǎn)要素的等級(jí)分布進(jìn)行分析,是為風(fēng)險(xiǎn)評(píng)估。最后,通過上述研究過程,從建筑學(xué)角度建立四個(gè)專項(xiàng)醫(yī)療安全問題的風(fēng)險(xiǎn)控制模型,并根據(jù)風(fēng)險(xiǎn)要素的風(fēng)險(xiǎn)等級(jí)及其在建筑學(xué)范疇內(nèi)的可控程度,確立了每類問題的控制要點(diǎn),并據(jù)此提出空間環(huán)境視角的控制策略,是為風(fēng)險(xiǎn)控制。(1)針對(duì)醫(yī)療失誤的空間環(huán)境控制策略可概括為:提高空間組織的高效精益、控制空間環(huán)境的感知混亂度、創(chuàng)造有利于減輕疲勞感的工作環(huán)境、提升就診環(huán)境的患者安全感。(2)針對(duì)醫(yī)源性感染的空間環(huán)境控制策略可概括為:通過空間環(huán)境設(shè)計(jì)改善微生物環(huán)境、減少患者院內(nèi)轉(zhuǎn)移以及控制人員之間的接觸行為。(3)針對(duì)意外傷害的空間環(huán)境策略可概括為:完善功能布局盡量減少患者不必要的移動(dòng)、盡可能提供移動(dòng)過程中的各項(xiàng)支撐需求、創(chuàng)造有利于積極護(hù)理的護(hù)理環(huán)境。(4)針對(duì)職業(yè)暴露的空間環(huán)境策略可概括為:通過空間環(huán)境措施削弱暴露源、通過建筑空間布局控制危害范圍、通過醫(yī)療操作環(huán)境的改善控制侵入行為、針對(duì)特定侵入途徑設(shè)置建筑學(xué)角度的技術(shù)屏障。
[Abstract]:The rational thinking of architecture perspective on medical security is a demand of the era. The elements of building space environment research devoted to the influence of medical safety, relevant risk control provides theoretical and practical basis. Medical security is a serious public health problem is related to life and health, social stability and frequent hospital safety. The medical security level event to display the present stage our country did not meet the security needs of the people. The risk control of medical security is a systematic engineering, architectural space environment as the bearer of the medical activities of the risk control platform is an important part of the architectural design of the hospital safety is not only the body safety, more important is the core goal of medical security security architecture should take the role in system engineering, from the aspect of building areas to find new ways to solve the medical security problems, and And ultimately to promote social development and individual freedom. This study from the perspective of medical safety, based on the system theory, the related thought of security as a guide to medical experience feedback and the actual survey data as the basis, the effect of space environment on the psychological behavior for the connection, complete medical security and environmental factors in the space the docking of theoretical research and practice of two aspects, to improve the security of hospital building design, provide the basis for risk control and design practice, in order to play a positive role in space environment on medical activities, to avoid or reduce the negative effects of space environment on medical activities. Medical security screening and space environment relevant and important in-depth study is formed with the premise of the outcome of the operation, so the research of this study based on the aspects of mining, established four aspects of problems, In order to medical errors, iatrogenic infection, accidental injury, occupation exposure. On the basis of each issue in accordance with the "- mechanism analysis -- risk factors -- Extraction risk level -- Analysis of risk control model construction, put forward the risk control strategy of" the idea of the special analytical properties. This study first clarified the mechanism the space between the environment and medical security, a clear understanding of the relationship between the two is the basis of risk control. Secondly, the medical safety data access, live observation of hospital environment, the selection of medical expert interview a number of channels specific space environment on the four issue of medical safety factors, risk identification is again. The space environment elements, the level of risk by using non confrontation type expert opinion collection, according to the influence and effect of two directions in frequency He determined the spatial elements of the environment risk grade, and the grade distribution of the elements of risk analysis for risk assessment. Finally, through the research process, the risk control model to build four special medical security problem from the angle of architecture, and according to the risk factors of the risk level and its controllable degree in architecture in the context of the establishment the control points of each kind of problem, and put forward the control strategy from the perspective of space environment, is to control risk. (1) according to the medical error space environment control strategy can be summarized as follows: to improve the efficiency of lean space organization, control of the space environment perception disorder, create a favorable working environment to reduce fatigue, improve with a sense of security medical environment. (2) for iatrogenic infection in the space environment control strategy can be summarized as follows: to improve the microbial environment through the design of the space environment, reduce the patients turn The contact behavior between the shift and control personnel. (3) according to the space environment strategy accident can be summarized as follows: perfect the function layout to minimize unnecessary movement of patients, as far as possible to provide the mobile process support demand, create a positive environment conducive to nursing care. (4) according to the space occupation exposure strategy can be summarized as: the space environment measures to minimize the exposure to the source, through the construction of space layout control the harm scope, control of intrusive behavior through medical operating environment improvement, according to the specific technical barriers pathways settings architecture perspective.

【學(xué)位授予單位】：哈爾濱工業(yè)大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：TU246.1
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本文編號(hào)：1638436